title: Endocrine complications after busulphan and cyclophosphamide based hematopoietic stem cell transplant: A single tertiary care centre experience.
abstract: BACKGROUND
  Endocrine complications are common after hematopoietic stem cell transplant (HSCT). Although HSCT is performed at various centers in India, no study is available for endocrine dysfunctions among them. This study was carried out with the objective to evaluate endocrine dysfunction among patients undergone HSCT in the past.
  
  
  METHODS
  We carried out a cross-sectional study in a 50 post-HSCT recipients (39 allogenic, 11 autologous). All relevant data were collected from patient's records. Samples for hormonal estimation were collected and stimulation tests for cortisol and growth hormone were interpreted based on peak values achieved during insulin tolerance test.
  
  
  RESULTS
  The mean age of patients was 26.3 ± 16.9 years (range 4-74). Adrenal insufficiency (AI) was present in 60%, hypergonadotropic hypogonadism (HH) in 60%, growth hormone deficiency (GHD) in 54%, hypothyroidism in 4%, hyperprolactinemia in 4%, new onset diabetes after transplant in 4%, and impaired fasting glucose in 6%. Multiple endocrine complications were common. GHD was present in 77% of children (n = 22) although height standard deviation score was not statistically different compared to those who didn't have GHD. HH was present in 36% of children. In adults (n = 28), 36% had GHD, all females had HH, and 89% of males had HH. Germ cell dysfunction with compensated Leydig cell dysfunction was the most common pattern of HH in males. Fifteen patients had graft versus host disease (GVHD). GVHD had no bearing on development of endocrine deficiencies. AI was related to duration after and type of transplant, but was unrelated to steroid intake.
  
  
  CONCLUSIONS
  Endocrine manifestations are common after HSCT; they can occur as early or late complications. All HSCT recipients should have endocrine evaluation as per prevailing guidelines.
authors.affiliation: Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India.
authors.forename: Abhay
authors.initials: A
authors.lastname: Gundgurthi
authors.forename: M K
authors.initials: MK
authors.lastname: Garg
authors.forename: Velu
authors.initials: V
authors.lastname: Nair
authors.forename: Rajeev
authors.initials: R
authors.lastname: Pakhetra
authors.forename: Satyanarayan
authors.initials: S
authors.lastname: Das
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Sharma
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Dutta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kharb
authors.forename: Rajan
authors.initials: R
authors.lastname: Kapoor
keywords: Adrenal insufficiency; diabetes; growth hormone deficiency; hematopoietic stem cell transplant; hypogonadism; hypothyroidism